同步视频监测侧方扩散反应在面肌痉挛手术中的应用

目的 探讨显微血管减压术(microvascular decompression,MVD)治疗面肌痉挛术中应用同步视频监测侧方扩散反应(lateral spread response,LSR)的意义.方法 回顾性分析105例行MVD且术中实施同步视频LSR监测的面肌痉挛病人的临床资料.分别将依据术中LSR监测及同步视频...     

绒球下入路微血管减压术治疗面肌痉挛疗效分析

目的 探讨绒球下入路微血管减压术（MVD）治疗面肌痉挛（HFS）的安全性和有效性。方法 回顾性分析2020年7月至2021年6月采用绒球下入路MVD治疗的233例HFS的临床资料。结果 术中发现单一血管压迫166例（71.2%）,其中小脑前下动脉142例;多支血管压迫67例（28.8%）,其中椎动脉参与53例。术后1、3、6、12个月有效率分别为95.3%、94.8%、95.3%、94.8%。术后1年复发率为1.7%。术后发生并发症26例（11.2%）,其中无菌性脑膜炎10例,脑脊液鼻漏3例,迟发性面瘫6例,后组颅神经麻痹4例,听力损伤2例,小脑梗死1例。结论 绒球下入路MVD治疗HFS是一种安全的、有效的手术方法,可充分显露面神经根出脑干区,同时减少对小脑的牵拉,降低听力损伤风险。     

The critical warning sign of real-time brainstem auditory evoked potentials during microvascular decompression for hemifacial spasm

Objective

The aim of this study was to define the critical warning sign of real-time brainstem auditory evoked potential (BAEP) for predicting hearing loss (HL) after microvascular decompression (MVD) for hemifacial spasm (HFS).

第Ⅷ脑神经显微血管减压术治疗耳鸣六例报告及文献复习

目的 探讨第Ⅷ脑神经微血管减压术治疗耳鸣的疗效.方法 对临床1例耳鸣,2例三叉神经痛伴同侧耳鸣,及3例面肌痉挛伴同侧耳鸣患者实施了乙状窦后入路第Ⅷ脑神经微血管减压术,6例患者均进行16-38个月的随访以判断治疗效果.结果 术后6例中治愈2例,显效3例,无效1例.进行平均随访23个月,有3例治愈,2例显效,1例无效.无不良反应发生.结论 异常血管袢压迫第Ⅷ腩神经是耳鸣的病因之一,显微血管减压术治疗微血管压迫综合征性耳鸣是一种安全、有效的治疗方法.     

SCN2A mutation in an infant presenting with migrating focal seizures and infantile spasm responsive to a ketogenic diet

SCN2A mutations have been identified in various encephalopathy phenotypes, ranging from benign familial neonatal-infantile seizure (BFNIS) to more severe forms of epileptic encephalopathy such as Ohtahara syndrome or epilepsy of infancy with migrating focal seizure (EIMFS). Thus far, no particularly effective treatment is available for severe epileptic encephalopathy caused by SCN2A mutations in children.We present the case of a boy who developed seizures on the third day of life and received a diagnosis of EIMFS based on his clinical presentations and electroencephalography reports. Antiepileptic drugs, namely oxcarbazepine, phenytoin, valproate, levetiracetam, and clonazepam, as well as adrenocorticotropic hormone therapy failed to reduce the severity of the seizures. Seizure pattern changed to infantile spasm with extensor thrust since 5?months of age. A ketogenic diet consisting of a medium-chain triglyceride recipe was introduced at 8?months of age and the seizures were resolved in the following 10?months. A de novo mutation in SCN2A (c.573G?>?T; p.W191C) was proven through next-generation sequencing.     

耳后锁孔入路显微手术治疗原发性面肌痉挛

目的探讨原发性面肌痉挛的显微手术治疗方法,以便进一步提高其临床治疗效果及降低并发症的发生率。方法121例原发性面肌痉挛患者均采用耳后锁孔入路开颅行微血管减压术,放置适当大小的Teflon垫棉隔离面神经出脑干区的相关责任血管。结果术后121例均获3～36月随访,总有效率为98.35%。术后出现耳鸣及听力减退4例,迟发性面瘫1例,小脑梗死1例。结论耳后锁孔入路微血管减压手术是目前治疗原发性面肌痉挛最有效的方法。手术中仔细辨别相关的责任血管,面神经出脑干区的充分显露和有效减压,以及垫棉放置的位置和大小等,是直接影响术后临床效果的关键。     

Ergonovine maleate test in various anginal syndromes

The ergonovine maleate (EM) test has been performed in fourgroups of 10 patients each: (A) variant angina; (B) angina atrest with ST segment depression during pain; (C) effort angina;(D) atypical chest i pain. EM was injected i.v. (highest dose 0-4 mg) first in the CoronaryCare Unit and thereafter during coronary angiography. EM causedcoronary spasm with angina and ST segment elevation in everypatient of group A and in one patient of group B. In five and four patients of groups B and C, respectively, EMinduced angina and ST segment depression without any localizedcoronary spasm, the coronary angiography showing only a diffusenarrowing of the coronary vessels; these patients had the lowesteffort tolerance and the most severe coronary lesions. Spontaneous or induced coronary spasm in patients with anginaat rest and ST segment depression during chest pain did notoccur in this study. An increase of the peripheral and/or coronaryresistances due to EM could be the mechanism of the ischemicattack in patients with severe coronary lesions.     

The Effects of Botulinum Toxin a on Ephaptic Transmission in Idiopathic Hemifacial Spasm

Objective: Lateral spreading and synkinetic responses of blink reflex are a sign of ephaptic transmission in idiopathic hemifacial spasm (HFS). The aim of this study was to evaluate the effect of botulinum toxin A (Btx A) on ephaptic transmission in idiopathic HFS. Methods: Thirty-three patients with idiopathic HFS were investigated. Btx A was injected only into the affected orbicularis oculi (OC) muscle. Electrophysiological studies were performed before and three weeks after the Btx A injection. Results: After Btx A, the latencies of motor response and blink reflexes elicited from the OC muscle were significantly increased. The lateral spreading was not obtained in the OC muscle, while the orbicularis oris muscle response was not changed. There were no significant differences in the synkinetic responses of blink reflex. During needle EMG examination, positive sharp waves and fibrilation potentials were observed due to chemodenervation only in the OC muscle. Conclusion: Btx A affects only the neuromuscular junctions of the injected muscle and has no effect upon ephaptic transmission.     

内镜辅助的神经微血管减压术(附31例报告)

目的 探讨内镜辅助的神经微血管减压术的方法和技术要点.方法 2008年1月～2009年12月间共治疗原发性三叉神经痛17例,面肌痉挛12例,原发性三叉神经痛合并面肌痉挛2例,手术采用枕下小切口乙状窦后入路,在内镜下辅助下行神经微血管减压术,对临床资料和治疗结果进行回顾性分析.结果 31例患者术中均发现责任血管压迫并予分离、减压.本组患者无死亡,术后1例出现蛛网膜下腔出血,1例发生颅内感染,经治疗后痊愈.术后随访5个月～2年,症状完全缓解28例,症状减轻3例,无复发.结论 在神经微血管减压术应用内镜,有助于分辨责任血管,减压彻底,具有微创、安全的优点.